Pregnancy with condyloma acuminatum
Introduction
Introduction to pregnancy with condyloma acuminata The incidence of condyloma acuminata is closely related to the immune status of the body. The cause of pregnancy complicated with condyloma acuminata is the inhibition of the immune function of pregnant women, combined with increased vaginal secretions and moist and warm vulva, which is prone to genital warts. The lesion grows rapidly during pregnancy and shrinks or naturally resolves after delivery. Condyloma acuminata is a common sexually transmitted disease in recent years, second only to gonorrhea. The pathogen of condyloma acuminata is human papillomavirus, a total of 68 subtypes, of which low-risk 6 subtypes and II subtypes are the most common pathogens. Sexual intercourse is the main route of transmission, but a few are non-sexual contact. The most common part of the genital area (the posterior labia and the inner side of the labia minora) is 93%, followed by the cervix (where the bulge type is less flat) and 32%, and the vagina only accounts for 18%. basic knowledge The proportion of sickness: 0.01% Susceptible population: pregnant women Mode of transmission: sexually transmitted contact Complications: bacterial vaginitis
Cause
Pregnancy with condyloma acuminata
Human papillomavirus infection
Human papillomavirus (HPV) belongs to the genus Papilloma vacuolar virus A. It is a group of small DNA viruses with a diameter of 55 nm, a lipoprotein-free envelope, a symmetric icosahedron composed of 72 virus shells, and a genome of one. Double-stranded DNA containing 7.9 kb and a molecular weight of 5,000,000. In terms of genetic structure and function of HPV, its open reading frames (ORFs) E6, E7, E1, E2, E4, E5, L1, L2 and E3, E8 And the corresponding gene-encoded proteins are highly valued. HPV has many types and subtypes. People initially determined a new HPV type by using less than 50% of known HPV type DNA cross-hybridization rates, above 50. The % cross-hybridization rate and the endonuclease are different to determine the new subtype. The current typing standard is: the E6, E7 and L1 sequences of the pending HPV genomic ORF are less than 90% homologous to the known type. Types, 2% to 10% of the differences are new subtypes, and differences of less than 2% are isotype variations. Based on PCR technology, HPV has been divided into more than 100 types, of which about 75 have completed molecular cloning and gene sequencing. Condyloma acuminata HPV is susceptible to infection of mucosal and squamous epithelial cells of the skin. Small wounds at the site of sexual contact promote infection. The integrin of the basal cell layer may be a receptor for virus attachment. The L1 protein binds to the virus and enters the cell. Coordination, HPV antigenicity in basal cells is weak, easy to escape the recognition and elimination of the body's immune system, its genes express E1 and E2 early, E1 protein is a nucleic acid phosphorylated phospholipid protein, and has adenine and guanine triphosphorylation Enzyme activity and DNA helicase activity; E2 protein is both an activator of transcription and a limiting agent, which initiates transcriptional regulation by immobilization in 12-nucleoside resuscitation (ACCN6GGT), and carries high replication with the process of differentiation into spine cells. >50) The complete viral particles of HPV DNA appear in the pelagic cells, and the E6, E7-encoded proteins play important roles in transforming cells, especially in high-risk HPV (HPV16, HPV18) infection, in general, early ORF The region E1-E8 is mainly responsible for the replication of the virus and has the transformation property. The L1 and L2 in the late region are related to proliferation and replication, and the virus particles are loaded in the terminal differentiation stage of keratinocytes. , With the death of progeny virus shedding corneocytes released.
Humoral immunity
In terms of humoral immunity research, HPV antigens have been used to extract viral particles, bacterially expressed fusion proteins, synthetic peptides, etc. Most of the results show that the host antibody is mainly directed to the capsid protein L2, with the latest recombinant eggshell protein L1 or L1 L2 antigen. (VLPs) studies have shown that HPV antibodies are type-specific, positive results are strongly associated with disease history, antibody production is slow, and titers are low. A group of newly infected HPV16 patients have a mean positive rate of serum antibody for nearly one year. The average titer is 1:100. The serum antibody maintenance time is still unclear. It has been reported that the condyloma acuminata antibody can last for several decades. The cellular immune response of HPV has been considered to play an important role in inhibiting virus reactivation and carcass regression. The intensity of T cell response is related to the occurrence, duration and regression of corpus callosum. In recent years, studies have found that lymphoid hyperplasia response to E6 and E7 is associated with lesion regression and clearance of HPV infection; in peripheral blood of women with cervical cancer, draining lymph nodes Cytotoxic T lymphocytes (CTLs) corresponding to the E4 protein were detected in cancer tissues.
Prevention
Pregnancy with condyloma acuminatum prevention
Controlling sexually transmitted diseases is the best way to prevent CA. The treatment of patients and their sexual partners was found; hygiene education and sexual behavior control were carried out; condoms have the effect of preventing HPV infection.
Do the following to prevent genital warts:
1. Resolutely put an end to sexual disorder: 60% of patients with genital warts are infected through sexual contact. One of the family members is infected with the society, and the spouse is transmitted through sexual life. It is also possible to pass on to other people in the family through close contact with the family. This brings both physical pain and family disharmony and mental stress. Therefore, improving sexual ethics and not taking extramarital sex is an important aspect to prevent the occurrence of genital warts.
2. Prevent contact infection: do not use other people's underwear, swimwear and bath tub; do not wash the pond in the public bath, promote shower, do not sit directly in the bath seat after bathing; use the squat toilet in the public toilet; Wash your hands with soap before; do not swim in the pool with high density and disinfection.
3. Pay attention to personal hygiene: clean the vulva daily, change the underwear, and clean the underwear separately. Even family members should be able to make one person and one basin, and the towels should be used.
4. Spouse should be prohibited from sexual life after illness. If the spouse has only physical therapy, although the genital warts disappeared, the patient still has human papillomavirus, and should also receive comprehensive treatment of oral and external washing drugs, and review after treatment. If you have sex during this time, you can use a condom for protection.
Complication
Pregnancy with complications of condyloma acuminatum Complications, bacterial vaginitis
Pregnant women suffer from genital warts and have a sympathetic risk of vertical transmission. Fetal intrauterine infection is extremely rare. It has been reported that individual fetuses are deformed, most of them are infected through soft birth canals, and there is a possibility of laryngeal tumors in early childhood.
Symptom
Pregnancy with condyloma acuminata symptoms common symptoms small labia and vestibule also ... perineal ulcers genital itching vaginal purulent discharge
Multiple squamous epithelial papillary hyperplasia, hard, prominent in the epidermis, rough surface, fleshy pedicle, poly-generating group, can also be fused together to form plexiform, papillary growth, or cockscomb, cauliflower Or mulberry-like. There are many genital warts in the genital tract during pregnancy, and the lesions are large, multi-regional and multi-morphological.
If pathological examination, the epidermal cells are arranged neatly under light microscope, the squamous epithelium is papillary hyperplasia, the acanthosis cells proliferate, and sometimes vacuoles are formed, the cells become larger, the cytoplasm becomes lighter, and the nucleus is basophilic.
Examine
Pregnancy with condyloma acuminata
If pathological examination, the epidermal cells are arranged neatly under light microscope, the squamous epithelium is papillary hyperplasia, the acanthosis cells proliferate, and sometimes vacuoles are formed, the cells become larger, the cytoplasm becomes lighter, and the nucleus is basophilic.
The lesion features are obvious and easy to diagnose. If pathological, under the light microscope, the epidermal cells are arranged neatly, the squamous epithelium is papillary hyperplasia, the acanthosis cells proliferate, sometimes vacuoles are formed, the cells become larger, the cytoplasm becomes lighter, and the nucleus is basophilic.
Diagnosis
Diagnosis and differentiation of pregnancy complicated with condyloma acuminatum
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Generally, according to the growth site and clinical manifestations of sputum, the diagnosis of condyloma acuminata is not difficult, and the diagnosis points are generally distinguished from the following diseases:
1, pseudo-condyloma mainly occurs in the female labia minora and vaginal vestibule, symmetric distribution, usually white or reddish small papules, a small number of polyps, pathological examination can be distinguished from condyloma acuminata.
2, flat wet warts are secondary syphilis, sometimes its shape is similar to condyloma acuminata, but the syphilis serum test is strongly positive.
3, genital squamous cell carcinoma Condyloma acuminata can grow up rapidly during pregnancy, and even erosive, exudate, easy to be confused with squamous cell carcinoma. However, the latter is more common in patients over 40 years old, and the lesion is hard and easy to bleed. The pathological examination shows that it is composed of different proportions of squamous cells.
